[The Structural Reform of The Psychotherapy Guidelines in Germany]. / Die neuen Behandlungselemente der Psychotherapiestrukturreform.

OBJECTIVES: Our study investigates how psychotherapists implement and assess the newly introduced elements of the structural reform of the psychotherapy guideline in Germany. METHODS: We asked psychotherapists about their experiences with the structural reform in semi-structured interviews. The data was analysed using qualitative content analysis. RESULTS: A total of 37 h of audio material from 41 psychotherapists were available. The interviews showed that acute treatment and relapse prevention are welcomed by psychotherapists. However, due to lack of appointment capacity as well as conceptual barriers, these are rarely used. Concerning psychotherapeutic assessment consultations, the opinions were heterogeneous. CONCLUSION: Individual aspects of the new care elements are assessed positively. However, these can only be implemented to a limited extent and are not sufficient to significantly improve the strained supply situation.

[Psychotherapeutic appointments given by Associations of Statutory Health Insurance Physicians in 2019 : An analysis differentiated by appointment type and region]. / Vermittlung der Terminservicestellen Psychotherapie im Jahr 2019 : Eine Auswertung differenziert nach Vermittlungsanliegen und KV-Region.

BACKGROUND: One provision of the Care Provision Strengthening Act in Germany was that psychotherapeutic appointments (psychotherapeutic consultation, acute care, and probatory sessions) are now arranged through the Association of Statutory Health Insurance Physicians organizations. We examined how many appointments were requested and given in 2019, differentiated by appointment type and by city state versus areal state organizations. METHODS: The frequency of requests and appointments made in 2019 were collected from the Association of Statutory Health Insurance Physicians organizations in Germany using a questionnaire. Statistical analysis comprised descriptive evaluations and a Kruskal-Wallis test. RESULTS: Data for appointments were available from 17 and information on requests from 16 Association of Statutory Health Insurance Physicians organizations. A total of 134,578 appointments were given. The number of granted appointments ranged from 193 to 21,810, revealing substantial differences between the individual organizations. The share of psychotherapeutic consultations among all psychotherapeutic appointments granted amounted to a median of 92%. Per organization, appointments were given for a median of 87% of requests for a psychotherapeutic consultation (range 56-100%), 96% for acute care requests (range 29-100%), and 97% for probatory session requests (range 27-100%) (n = 16, respectively). There were minor differences between city states and areal states in granting acute care and probatory sessions. DISCUSSION: There are deficits both in city state and areal state Association of Statutory Health Insurance Physicians organizations in terms of granting acute care and probatory sessions. Our results do not allow conclusions about distance to the practices or waiting times.

Suicidal ideation and attempts in adults seeking outpatient psychodynamic psychotherapy.

Suicide is an important cause of death in patients with mental health disorders, but little is known about the occurrence of suicidal ideation and attempts in outpatient psychotherapy patients. The aim of this study was to identify the proportion of patients with and correlates of suicidal ideation and attempts in community-based psychotherapy practices. Using 983 applications for reimbursement of psychotherapy from individual patients, reports about suicidal thoughts and suicide attempts were extracted along with demographic, biographic and clinical data. Multivariate logistic regression analysis was used to identify correlates of suicidal ideation and attempts by calculating odds ratios (ORs). Among the patients, 19% presented with suicidal thoughts (11% currently and 8% in the past) and 6% with suicide attempts. Important correlates of suicidal thoughts were male gender (OR 1.7), lower education (OR 1.8), early retirement (OR 2.9), death of a parent when younger than 5 years old (OR 3.3), violence experienced from various people (OR 2.1), self-harm behaviour (OR 7.9) and alcohol misuse (OR 1.7). Suicide attempts were associated with male gender (OR 5.6), lower education (OR 4.2), violence experienced from partner (OR 2.5) or from various people (OR 9.5) and self-harm behaviour (OR 15.0). These results show that the proportion of suicidal patients seeking outpatient psychotherapy is high. It should therefore be a central topic in clinical training. Biographic data such as the loss of a parent at an early age or experiencing violence are associated with who is at increased risk and should be explored in detail.

[Outpatient Psychotherapy Before and After the Reform of the Psychotherapy Directive of 2017: Data from Practices with and without Psycho-Oncologic Specialty]. / Zustandekommen von ambulanter Psychotherapie vor und nach der Psychotherapiestrukturreform von 2017 ­ Daten aus Praxen mit und ohne psychoonkologischem Schwerpunkt .

BACKGROUND: The reform of the German psychotherapy directive in 2017 resulted in several changes for non-hospital-based psychotherapists. We examined whether patients received psychotherapy following their initial consultation more frequently after the reform than before. METHODS: Using records from psychotherapy practices in a retrospective cohort study, we investigated the frequency of a psychotherapy after the patients' initial consultation. We compared a time frame of three years before and after the reform. A potential association between reform and psychotherapy received was analysed via logistic regression. RESULTS: Our analysis comprised 1548 records from 9 psychotherapy practices, consisting of 755 records before and 793 records after the reform. Before the reform, 40% (n=303) of the patients who had an initial consultation went on to receive psychotherapy. After the reform, 46% (n=360) of initial consultations were followed by psychotherapy (including acute care). The logistic regression analysis showed a 36% increased probability of receiving psychotherapy after an initial consultation after the reform in comparison to before the reform (odds ratio 1.36 after vs. before reform, 95% confidence interval 1.09 - 1.68). CONCLUSION: Our results indicate a higher chance of receiving psychotherapy after an initial consultation after the reform compared to before the reform. Our data do not contain information as to whether the absolute number of psychotherapy appointments in the practices increased after the reform.

["It's Left a Bitter Taste" Psychotherapists' Perspectives on the Abolition of the German Assessment Procedure for Outpatient Psychotherapy]. / "Es hat so einen etwas bitteren Beigeschmack" Die Abschaffung des Antrags- und Gutachterverfahrens aus Sicht von Psychotherapeut*innen in der ambulanten Versorgung.

BACKGROUND AND RESEARCH QUESTION: In 2019, the abolition and replacement of the present German assessment procedure for outpatient psychotherapy was resolved and adopted into law. This study examined what psychotherapists think about the new plan. METHODS: We conducted semi-guided interviews with psychotherapists about their experience and opinion of the current psychotherapeutic care situation in Germany. Statements about the assessment procedure were evaluated using qualitative text analyses. We compared the psychotherapists' opinion on the assessment procedure with the psychotherapeutic approach as well as the age group. RESULTS: Of 41 psychotherapists 27 reported their thoughts about the assessment procedure. The following themes could be drawn from their statements: Appreciation as well as criticism of quality control of the procedure, worries about a future loss of economic and treatment certainty, perception that the assessment procedure questions one's competence, disapproval of the low remuneration of the reports, the connection between individual attitudes towards the assessment report and conscientiousness in writing the reports, and the lack of transparency of the legislative initiative. Psychodynamic psychotherapists wanted to keep the assessment procedure slightly more often compared to behavioural psychotherapists; child and youth psychotherapists wanted to keep it more often than psychotherapists for adults. DISCUSSION: Psychotherapists perceive the reform of the assessment procedure as a process with a substantial impact on their current clinical practice as well as their psychotherapeutical identity. To improve the quality and acceptance of the future quality assurance procedure, psychotherapists should be an active part of the development process.

[Is the number of psychotherapy sessions for patients with depression associated with the severity of the disease?] / Hängen die Stundenkontingente für ambulante Psychotherapie zur Behandlung von Depressionen mit deren Schweregrad zusammen?

OBJECTIVE: This study investigated how the number of sessions for outpatient psychodynamic psychotherapy among patients with depressive disorders is associated with the severity of the disease. METHODS: From a random sample of 1000 applications for reimbursement of outpatient psychodynamic psychotherapy, we selected those in which a diagnosis of depression with a severity rating (ICD-10 F32 or F33) was coded. The association of levels of depression severity (mild, moderate, and severe) with the number of sessions requested and the number of sessions endorsed by the reviewer was investigated using Spearman's rank correlation. If the application was for a continuation of an ongoing therapy, the previous sessions were taken into account too. RESULTS: A total of 521 (52%) applications contained a diagnosis of F32 and/or F33. Out of these, 63 (12%) were coded as mild, 349 (67%) as moderate, and 50 (10%) as severe. There were 75 sessions applied for in patients with mild depression (median), 50 in patients with moderate depression, and 50 in patients with severe depression, whereby the range within each severity group was considerable (10 to 327 sessions) and the correlation was low (Rho -0.10). The median number of endorsed sessions was 74 in patients with mild depression, 50 in patients with moderate, and 50 in patients with severe depression. Here, too, the range was high (0 sessions to 327 sessions) and the association weak (Rho -0.11). DISCUSSION: There is no evidence that psychotherapists determine the necessary number of sessions solely based on the severity of the diagnosis.

Pre-Sleep Arousal Scale (PSAS) and the Time Monitoring Behavior-10 scale (TMB-10) in good sleepers and patients with insomnia.

OBJECTIVES: Pre-sleep arousal and time monitoring behavior are two putative factors involved in the development and maintenance of insomnia. We investigate two questionnaires measuring these factors in good sleepers and patients with insomnia. PARTICIPANTS: A sample of 96 patients with non-organic insomnia according to ICD-10 and 208 good sleepers completed the Pre-Sleep Arousal Scale (PSAS), the Time Monitoring Behavior-10 scale (TMB-10), the Beck Depression Inventory (BDI)-II, the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI) and the State-Trait Anxiety Inventory (STAI). METHODS: In this study, 95% quantile cut-off scores were determined for good sleeper in the age and gender mathed subgroups of the insomnia group. Multiple logistic regression analysis was used to determine variables predicting above-threshold values in the two target questionnaires. Included predictors were age, gender as well as ISI, BDI-II, STAI-1 and -2 total scores. RESULTS: Good sleepers showed 95% quantiles between 12.2 and 23.8 for PSAS and between 7.5 and 12.7 for TMB-10. Approximately 40% of patients with insomnia had scores above these cut-offs for PSAS and ca. 25% for TMB-10. Female gender and anxiety were variables associated with scores above cut-off on the PSAS. Insomnia severity and anxiety were associated with scores above cut-off on the TMB-10. CONCLUSIONS: These findings underline the importance of PSAS and TMB-10 in the diagnostic investigation of insomnia and indicate that time monitoring is related to increased insomnia severity. Further research may investigate the impact of the corresponding two constructs on response rates to cognitive-behavioral treatment for insomnia.